Scrotal Lump

Question 1

Hx of scrotal lump

Answer 1

Time of onset

Associated symptoms

Previous episodes

Question 2

Examination

Answer 2

6S:
Site
Size
Shape
Symmetry
Skin changes
Scars present

When palpating…
CAMPFIRE
Consistency
Attachments
Mobility
Pulsation
Fluctuation
Irreducibility
Regional lymph nodes
Edge

+ Tenderness, temprature and transilluminsation.

Make sure to see if you can separately palpate all structures in scrotum

Question 3

Investigations

Answer 3

1st line is USS of scrotum

Blood tests or further imaging miay be warrante

Question 4

Explain hydrocoele

Answer 4

Abnormal collection of peritoneal fluid between parietal and visceral layers of the tunica vaginalis.

Question 5

Clinilca features of hydrocoele

Answer 5

Painless fluctuatin swelling

Transillumination

Unilateral or bilateral

Can happen congenitally

Question 6

Management of congenital hydrocoele

Answer 6

Usually regress spontanesouly by one or two years of age

No treatment is usually needed

If there is a patent processus vaginalis ligation will be required to stop recurrence

Question 7

Causes of hydrocoele in older men

Answer 7

Primary idiopathic

Secondary due to trauma, infetion or malignancy.

Between 20-40 with presentation should have urgent USS

Question 8

What is varicocoele

Answer 8

Abnormal dilation of the pampiniform venous plexus within the spermatic cord.

Question 9

Clinical features of varicocoele

Answer 9

Lump as a bag of worms or with a dragging sensation.

May disappear on lying flat

Examine lying down and standing up and perform a valsalva manoeuvre

Question 10

Where are most varicocoeles found?

Answer 10

On the left side as it drains into left renal vein instead of IVC as done on the right

Question 11

Complications of varicocoele

Answer 11

Can cause infertility and testicular atrophy by increasing intra-scrotal temperature

Semen analsysis and referral to urology should be done.

Question 12

Red flag signs of varicocoele

Answer 12

Acute onset

Right sided

Remain when lying flat

These should be investigated urgently.

Question 13

Treatment of asymptomatic varicocoeles

Answer 13

No need for tx

Question 14

Treatment of symptomatic varicocoele

Answer 14

Surgical by embolisation by interventional radiologist.

Open or laparoscopic approach for ligation of the spermatic veins.

Question 15

Explain epididymal cysts

Answer 15

Aka spermatocoele

Benign fluid-filled sacs arising from the epididymis

Question 16

Clinical features of epididymal cysts

Answer 16

They present as a smooth fluctuant nodule and found above and separate from the testis.

It will transilluminate and are often multiple.

Question 17

When are epididymal cysts seen?

Answer 17

Common pathoogy seen in middle aged men.

Question 18

Treatment of epididymal cysts

Answer 18

Usually doesnt give symptoms and no association of malignancy.

This means that they dont generally need treatment

If the yare very large and symptomatic surgery might be required, try to avoid this in younger men as infertility can ensue.

Question 19

Examination of testis of inguinal hernia

Answer 19

You cannot get above an inguinal hernia within the scrotum.

It may disappear upon lying flat

Question 20

Benign testicular lesions

Answer 20

Leydig cell tumours

Sertoli cell tumours

Lipomas

Fibromas

Question 21

Explain orchitis

Answer 21

usually due to mumps.

Rest and analgesia and it should self-limit

Intra-testicular abscess can be the cause which would need drainage and occasionally orchidectomy

Question 22

Way to distinguish between lumps

Answer 22